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Background: Despite the United States Preventive Services Task Force recommendation to screen adults for unhealthy alcohol use, the implementation of alcohol screening in primary care remains suboptimal. Methods: A pre and post-implementation study design that used Agile implementation process to increase screening for unhealthy alcohol use in adult patients from October 2021 to June 2022 at a large primary care clinic serving minority and underprivileged adults in Indianapolis. Results: In comparison to a baseline screening rate of 0%, the agile implementation process increased and sustained screening rates above 80% for alcohol use using the Alcohol Use Disorders Identification Test – Consumption tool (AUDIT-C). Conclusions: Using the agile implementation process, we were able to successfully implement evidence-based recommendations to screen for unhealthy alcohol use in primary care. [ABSTRACT FROM AUTHOR]

Researchers and practitioners recognise the importance of context when implementing healthcare interventions, but the influence of wider environment is rarely mapped. This paper identifies the country and policy-related factors potentially explaining the country differences in outcomes of an intervention focused on improving detection and management of heavy alcohol use in primary care in Colombia, Mexico and Peru. Qualitative data obtained through interviews, logbooks and document analysis are used to explain quantitative data on number of alcohol screenings and screening providers in each of the countries. Existing alcohol screening standards in Mexico, and policy prioritisation of primary care and consideration of alcohol as a public health issue in Colombia and Mexico positively contributed to the outcome, while the COVID-19 pandemic had a negative impact. In Peru, the context was unsupportive due to a combination of: political instability amongst regional health authorities; lack of focus on strengthening primary care due to the expansion of community mental health centres; alcohol considered as an addiction rather than a public health issue; and the impact of COVID-19 on healthcare. We found that wider environment-related factors interacted with the intervention implemented and can help explain country differences in outcomes. [ABSTRACT FROM AUTHOR]

Background and Aims: The increasing trend in alcohol consumption among women, exacerbated by the COVID‐19 pandemic, is of growing concern. Screening, brief intervention, and referral to treatment in primary care is an efficacious and cost‐effective treatment approach for unhealthy alcohol use. However, disparities exist in delivery of brief interventions by sex, age and race/ethnicity. This study measures brief intervention rates among eligible patients by sex, age and race/ethnicity and their intersectionality, in the context of a program of systematic alcohol screening and brief intervention program in adult primary care in a large, integrated health‐care delivery system. Design, Setting and Participants: This was a population‐based observational study among primary care clinics in an integrated health‐care delivery system in Northern California, USA. The participants comprised adult (18+) patients (n = 287 551) screening positive for unhealthy alcohol use between January 2014 and December 2017. Measurements: Receipt of brief intervention, patient and provider characteristics from electronic health records. Findings Multi‐level logistic regression showed that women had lower odds of receiving brief intervention than men among all age, racial/ethnic groups and drinking levels. Sex differences were greater among those aged 35–49 years [odds ratio (OR) = 0.67, 95% confidence interval (CI) = 0.64, 0.69]) and 50–65 years (OR = 0.69, 95% CI =0.66, 0.72) than among other age groups. Sex differences in odds of receiving brief intervention were greater for the Latino/Hispanic group for women versus men (OR = 0.69, 95% CI = 0.66, 0.72) and smaller for the Asian/Pacific Islander group (OR = 0.76, 95% CI = 0.72, 0.81). Conclusion: In the United States, compared with men, women appear to have lower odds of receiving brief intervention for unhealthy alcohol use across all age groups, particularly during middle age. Black women and Latina/Hispanic women appear to be less likely to receive brief intervention than women in other race/ethnicity groups. Receipt of brief intervention does not appear to differ by drinking levels between men and women. [ABSTRACT FROM AUTHOR]

Background: Unhealthy alcohol use is a significant health issue for the US population. The US Preventive Services Task Force (USPSTF) recommends screening adults 18 years or older for unhealthy alcohol use during primary care visits. Objectives: To evaluate alcohol screening among ambulatory visits made by US adult primary care patients and identify characteristics predictive of alcohol screening. Design: A series of cross-sectional analysis of the National Ambulatory Medical Care Survey (NAMCS) data collected from 2014 to 2016 was used to examine US primary care providers' use of alcohol screening questionnaires and delivery of counseling on alcohol use. Participants: A total of 19,213 visits made by patients aged 18 years or older to a US primary care physician trained in family medicine or internal medicine. Main Measures: Administration of a validated alcohol screening questionnaire and counseling/education on alcohol use. Variation in alcohol screening by patient demographic characteristics, reason for office visit, length of office visit, chronic medical conditions, evaluation by assigned primary care physician, new patient to practice, and region. Key Results: Alcohol screening with a validated questionnaire occurred during 2.6% (95% Cl: 0.9%, 4.3%) of visits. Alcohol counseling, provided either by the physician or by referral, was documented in 0.8% (95% Cl: 0.3%, 1.3%) of visits. Screening was significantly more likely if patients were seen by their assigned primary care physician (adjOR 4.38 (95% Cl: 1.41, 13.61)), a new patient to the practice (adjOR 4.18 (95% Cl: 2.30, 7.79)), or had several chronic medical conditions (adjOR 3.40 (95% Cl: 1.48, 7.78)). Patients' sex, race/ethnicity, age group, or length of appointment time was not associated with screening for unhealthy alcohol use. Conclusions: Screening for unhealthy alcohol use using a validated questionnaire is uncommonly performed during US primary care visits. Interventions or incentives may be needed to increase uptake of USPSTF alcohol screening recommendations. [ABSTRACT FROM AUTHOR]

Background: Although alcohol use disorder can complicate depression management, there is no standard process for assessing AUD symptoms (i.e., AUD diagnostic criteria) in primary care for patients who screen positive for depression. This study characterizes the association between depressive symptoms and high-risk drinking reported by primary care patients on screening measures in routine care. Then, using data from a novel clinical program, this study characterizes the association between depressive symptoms and AUD symptoms reported by primary care patients with high-risk drinking via an Alcohol Symptom Checklist.Methods: In this cross-sectional study, electronic health record data were obtained from patients who visited 33 Kaiser Permanente Washington primary care clinics between 03/2018 and 02/2020 and completed depression (PHQ-2) and alcohol consumption (AUDIT-C) screening measures as part of routine care (N = 369,943). Patients who reported high-risk drinking (AUDIT-C scores 7-12) also completed an Alcohol Symptom Checklist where they reported the presence or absence of 11 AUD criteria as defined by the DSM-5 (N = 8,184). Generalized linear models estimated and compared the prevalence of high-risk drinking (AUDIT-C scores 7-12) and probable AUD (2-11 AUD symptoms on Alcohol Symptom Checklists) for patients with and without positive depression screens.Results: Patients who screened positive for depression had a 131% higher prevalence of high-risk drinking than those who screened negative (5.2% vs. 2.2%; p < 0.001). Among patients with high-risk drinking, positive depression screens were associated with a significantly higher prevalence of probable AUD (69.8% vs. 48.0%; p < 0.001), with large differences in the prevalence of probable AUD observed with increasing PHQ-2 scores (e.g., probable AUD prevalence of 37.6%, 55.3% and 65.2%, for PHQ-2 scores of 0, 1, and 2, respectively). Although the overall prevalence of high-risk drinking was higher for male patients, similar patterns of association between depression screens, high-risk drinking, and AUD symptoms were observed for male and female patients.Conclusions: Patients with positive depression screens are more likely to have high-risk drinking. Large percentages of patients with positive depression screens and high-risk drinking report symptoms consistent with AUD to healthcare providers when given the opportunity to do so using an Alcohol Symptom Checklist. [ABSTRACT FROM AUTHOR]

Abstract: Introduction and objective: The ODHIN trial found that training and support and financial reimbursement increased the proportion of patients that were screened and given advice for their heavy drinking in primary health care. However, the impact of these strategies on professional accuracy in delivering screening and brief advice is underresearched and is the focus of this paper. Method: From 120 primary health care units (24 in each jurisdiction: Catalonia, England, the Netherlands, Poland, and Sweden), 746 providers participated in the baseline and the 12‐week implementation periods. Accuracy was measured in 2 ways: correctness in completing and scoring the screening instrument, AUDIT‐C; the proportion of screen‐negative patients given advice, and the proportion of screen‐positive patients not given advice. Odds ratios of accuracy were calculated for type of profession and for intervention group: training and support, financial reimbursement, and internet‐based counselling. Results: Thirty‐two of 36 711 questionnaires were incorrectly completed, and 65 of 29 641 screen‐negative patients were falsely classified. At baseline, 27% of screen‐negative patients were given advice, and 22.5% screen‐positive patients were not given advice. These proportions halved during the 12‐week implementation period, unaffected by training. Financial reimbursement reduced the proportion of screen‐positive patients not given advice (OR = 0.56; 95% CI, 0.31‐0.99; P < .05). Conclusion: Although the use of AUDIT‐C as a screening tool was accurate, a considerable proportion of risky drinkers did not receive advice, which was reduced with financial incentives. [ABSTRACT FROM AUTHOR]

Background and aims: There is a higher prevalence of unhealthy alcohol use among Indigenous populations, but there have been few studies of the effectiveness of screening and treatment in primary health care. Over 24 months, we tested whether a model of service-wide support could increase screening and any alcohol treatment. Design: Cluster-randomized trial with 24-month implementation (12 months active, 12 months maintenance). Setting: Australian Aboriginal Community Controlled primary care services. Participants: Twenty-two services (83 032 clients) that use Communicare practice software and see at least 1000 clients annually, randomized to the treatment arm or control arm. Intervention and comparator: Multi-faceted early support model versus a comparator of waiting-list control (11 services). Measurements: A record (presence = 1, absence = 0) of: (i) Alcohol Use Disorders Identification Test--Consumption (AUDIT-C) screening (primary outcome), (ii) any-treatment and (iii) brief intervention. We received routinely collected practice data bimonthly over 3 years (1-year baseline, 1-year implementation, 1-year maintenance). Multi-level logistic modelling was used to compare the odds of each outcome before and after implementation. Findings: The odds of being screened within any 2-month reference period increased in both arms post-implementation, but the increase was nearly eight times greater in earlysupport services [odds ratio (OR) = 7.95, 95% confidence interval (CI) = 4.04-15.63, P < 0.001]. The change in odds of any treatment in early support was nearly double that of waiting-list controls (OR = 1.89, 95% CI = 1.19-2.98, P = 0.01) but was largely driven by decrease in controls. There was no clear evidence of difference between groups in the change in the odds of provision of brief intervention (OR = 1.95, 95% CI = 0.53-7.17, P = 0.32). Conclusions: An early support model designed to aid routine implementation of alcohol screening and treatment in Aboriginal health services resulted in improvement of Alcohol Use Disorders Identification Test--Consumption screening rates over 24 months of implementation, but the effect on treatment was less clear. [ABSTRACT FROM AUTHOR]

Background: We have previously shown that service-wide support can increase the odds of alcohol screening in any 2-month period in a cluster randomized trial of service-wide support to Aboriginal and Torres Strait Islander Community Controlled Health Services (ACCHS). Here we report an exploratory analysis on whether the resulting pattern of screening was appropriate. Aim: we assess whether that increase in screening was associated with: (i) increased first-time screening, (ii) increased annual screening, (iii) whether frequently screened clients fell into one of four risk categories as defined by national guidelines. Methods: Setting and participants: 22 ACCHS; randomized to receive the support model in the treatment ('early-support') arm over 24-months or to the waitlist control arm. Intervention: eight-component support, including training, sharing of experience, audit-and-feedback and resource support. Analysis: records of clients with visits before and after start of implementation were included. Multilevel logistic modelling was used to compare (i) the odds of previously unscreened clients receiving an AUDIT-C screen, (ii) odds of clients being screened with AUDIT-C at least once annually. We describe the characteristics of a sub-cohort of clients who received four or more screens annually, including if they were in a high-risk category. Results: Of the original trial sample, 43,054 met inclusion criteria, accounting for 81.7% of the screening events in the overall trial. The support did not significantly increase the odds of first-time screening (OR = 1.33, 95% CI 0.81–2.18, p = 0.25) or of annual screening (OR = 0.99, 95% CI 0.42–2.37, p = 0.98). Screening more than once annually occurred in 6240 clients. Of the 841 clients with four or more screens annually, over 50% did not fall into a high-risk category. Females were overrepresented. More males than females fell into high-risk categories. Conclusion: The significant increase in odds of screening observed in the main trial did not translate to significant improvement in first-time or annual screening following implementation of support. This appeared to be due to some clients being screened more frequently than annually, while more than half remained unscreened. Further strategies to improve alcohol screening should focus on appropriate screening regularity as well as overall rates, to ensure clinically useful information about alcohol consumption. Trial Registration ACTRN12618001892202, retrospectively registered 16 November 2018 https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618001892202. [ABSTRACT FROM AUTHOR]

Background and Aims: Unhealthy alcohol consumption is a key concern for Aboriginal and Torres Strait Islander ('Indigenous') communities. It is important to identify and treat at‐risk drinkers, to prevent harms to physical or social wellbeing. We aimed to test whether training and support for Aboriginal Community Controlled Health Service (ACCHS) staff would increase rates of alcohol screening and brief intervention. Design Cluster randomized trial. Setting: Australia. Cases/Intervention/Measurements Twenty‐two ACCHSs that see at least 1000 clients per year and use Communicare as practice management software. The study included data on 70 419 clients, training, regular data feedback, collaborative support and funding for resources ($9000). Blinding was not used. The comparator was waiting‐list control (equal allocation). Alcohol Use Disorder Identification Test (AUDIT‐C) screening and records of brief interventions were extracted from practice management software at 2‐monthly intervals. Observations described the clinical actions taken for clients over each 2‐month interval. The baseline period (28 August 2016–28 August 2017) was compared with the post‐implementation period (29 August 2017–28 August 2018). We used multi‐level logistic regression to test the hypotheses that clients attending a service receiving active support would be more likely to be screened with AUDIT‐C (primary outcome) or to receive a brief intervention (secondary outcome). Findings We observed an increase in the odds of screening with AUDIT‐C for both groups, but the increase was 5.52 [95% confidence interval (CI) = 4.31, 7.07] times larger at services receiving support. We found little evidence that the support programme increased the odds of a recorded brief intervention relative to control services (odds ratio = 2.06; 95% CI = 0.90, 4.69). Differences in baseline screening activity between treatment and control reduce the certainty of our findings. Conclusions: Providing Aboriginal Community Controlled Health Services with training and support can improve alcohol (AUDIT‐C) screening rates. [ABSTRACT FROM AUTHOR]

This study explored internal consistency (α =.834), test-retest (rtt =.911), convergent validity, and internal structural validity of the Alcohol Use Disorders Identification Test (AUDIT) on a large university student sample. The 2-factor model fit the data best and measurement invariance was demonstrated for Latinx, but not undergraduate/graduate levels. [ABSTRACT FROM AUTHOR]

BACKGROUND: Population-based alcohol screening is recommended in primary care, and increasingly incentivized by policies, yet is challenging to implement. The U.S. Veterans Health Administration (VA) achieved high rates of screening using a national performance measure and associated electronic clinical reminder to prompt and facilitate screening and document results. However, the sensitivity of alcohol screening for identifying unhealthy alcohol use is low in VA clinics. OBJECTIVE: We aimed to understand factors that might contribute to low sensitivity of alcohol screening. DESIGN: This was an observational, qualitative study. PARTICIPANTS: Participants included clinical staff responsible for conducting alcohol screening and nine independently managed primary care clinics of a single VA medical center in the Northwestern U.S. APPROACH: Four researchers observed clinical staff as they conducted alcohol screening. Observers took handwritten notes, which were transcribed and coded iteratively. Template analysis identified a priori and emergent themes. KEY RESULTS: We observed 72 instances of alcohol screening conducted by 31 participating staff. Observations confirmed known challenges to implementation of care using clinical reminders, including workflow and flexibility limitations. Three themes specific to alcohol screening emerged. First, most observed screening was conducted verbally, guided by the clinical reminder, although some variability in approaches to screening (e.g., paper-based or laminate-based screening) was observed. Second, specific verbal screening practices that might contribute to low sensitivity of clinical screening were identified, including conducting non-verbatim screening and making inferences, assumptions, and/or suggestions to input responses. Third, staff introduced and adapted screening questions to enhance patient comfort. CONCLUSIONS: This qualitative study in nine clinics found that implementation of alcohol screening facilitated by a clinical reminder resulted primarily in verbal screening in which questions were not asked vertbatim and were otherwise adapted. Non-verbal approaches to screening, or patient self-administration, may enhance validity and standardization of screening while simultaneously addressing limitations of the clinical reminder and issues related to perceived discomfort. [ABSTRACT FROM AUTHOR]

Background: Although screening and brief intervention (SBI) are effective in reducing unhealthy alcohol use, major challenges exist in implementing clinician-delivered SBI in primary care settings. This 2006-2007 pilot study describes the impact of systems changes and booster trainings designed to increase SBI rates in a family medicine residency clinic which annually screened adults with a self-administered AUDIT-C questionnaire and used paper prompts to encourage physician interventions for patients with positive screens. Methods: Investigators added the Single Alcohol Screening Question (SASQ) to nursing vital signs forms, added a checkbox for documenting brief interventions to the clinicians' outpatient encounter form, and conducted onehour nurse and clinician booster trainings. Impact was measured using chart reviews conducted before implementing systems changes, then six weeks and six months post-implementation. Results: At all three time points screening rates using AUDIT-C plus SASQ exceeded 90%, however AUDIT-C screening decreased to 85% after 6 months (p=.025). Identification of unhealthy alcohol users increased from 4% to 22.9% at six weeks and 18.8% at six months (p=.002) using both screens. Nursing vital signs screening using the SASQ reached 71.4% six weeks after implementation but decreased to 45.5% at six months. Changes in clinician brief intervention rates did not achieve statistical significance. Conclusions: This is the second study reporting sustained primary care alcohol screening rates of more than 90%. Screening patients with SASQ and/or AUDIT-C identified a higher percentage of patients with unhealthy alcohol use. Dissemination of effective strategies for identifying unhealthy alcohol users should continue, while future research should focus on identifying more effective strategies for increasing intervention rates. [ABSTRACT FROM AUTHOR]

Background: The pediatric emergency department (PED) represents an opportune time for alcohol and drug screening. The National Institute of Alcohol Abuse and Alcoholism (NIAAA) recommends a two-question alcohol screen for adolescents as a predictor of alcohol and drug misuse. Objective: A multi-site PED study was conducted to determine the association between the NIAAA two-question alcohol screen and adolescent cannabis use disorders (CUD), cigarette smoking, and lifetime use of other drugs. Methods: Participants included 12–17-year olds (n = 4834) treated in one of 16 participating PEDs. An assessment battery, including the NIAAA two-question screen and other measures of alcohol, tobacco and drug use, was self-administered on a tablet computer. Results: A diagnosis of CUD, lifetime tobacco use or lifetime drug use was predicted by any self-reported alcohol use in the past year, which indicates a classification of moderate risk for middle school ages and low risk for high school ages on the NIAAA two-question screen. Drinking was most strongly predictive of a CUD, somewhat weaker for lifetime tobacco use, and weakest for lifetime drug use. This same pattern held for high school and middle school students and was stronger for high school students over middle school students for all three categories. This association was also found across gender, ethnicity and race. The association was strongest for CUD for high school students, sensitivity 81.7% (95% CI, 77.0, 86.5) and specificity 70.4% (95% CI, 68.6, 72.1). Conclusions/Importance: A single question about past year alcohol use can provide valuable information about other substance use, particularly marijuana. [ABSTRACT FROM AUTHOR]

Background: Foetal alcohol spectrum disorders (FASDs) are one of the most common preventable forms of developmental disability and congenital abnormalities globally, particularly in countries where alcohol is considered socially acceptable. Screening for alcohol use early in pregnancy can facilitate the detection of alcohol-exposed pregnancies and identify women who require further assessment. However, only a small percentage of children with FASD are identified in the United Kingdom. This may be partly attributed to a lack of awareness of the condition by National Health Service (NHS) health professionals. Methods: We developed an online survey to determine health care professionals' (midwives, health visitors, obstetricians, paediatricians, and general practitioners) perceived knowledge, attitudes, and clinical practices relating to alcohol in pregnancy and FASD. Results: There were a total of 250 responses to the surveys (78 midwives, 60 health visitors, 55 obstetricians, 31 paediatricians, and 26 general practitioners). About 58.1% of paediatricians had diagnosed a patient with foetal alcohol syndrome (FAS) or FASD and 36.7% worried about stigmatisation with diagnosis. Paediatricians reported the highest levels of FASD training (54.8%), with much lower levels in midwives (21.3%). This was reflected in perceived knowledge levels; overall, only 19.8% of respondents knew the estimated UK prevalence of FASD for example. Conclusions: We identified a need for training in alcohol screening in pregnancy and FASD to improve awareness and recognition by UK professionals. This could improve patient care from the antenatal period and throughout childhood. [ABSTRACT FROM AUTHOR]

Background: Implementation of alcohol screening and brief intervention in emergency departments is inadequate and the evidence base more mixed than in primary health care (PHC). This comparison study investigates the feasibility of alcohol screening and interventions by nurses in emergency departments, seven based in PHC and two in specialised health care clinics. The aim is to analyse barriers to implementation in these two contexts. Methods: A questionnaire was used among emergency nurses in the Kymenlaakso hospital district in Finland. The response rate was 71% (N = 112; PHC clinics n = 42; specialised clinics n = 38). The statistical differences in responses were analysed using the χ2 test. Open-ended questions were analysed qualitatively. Results: The nurses in specialised clinics treated patients with alcohol-attributable conditions/traumas more often than the nurses in PHC did (p < .001) but were less sure whether it was worthwhile to intervene in the patients’ alcohol use (p < .01). The reasons for reluctance included a lack of time and frustration resulting from discouraging results. The nurses in PHC were more familiar with brief interventions and used AUDIT-C more often than the nurses in specialised clinics (p < .05). Conclusions: The results indicate an intervention paradox in the emergency care setting: compared to nurses in PHC clinics, nurses in specialised health care clinics work more often with intoxicated patients but they are less willing to implement alcohol screening and interventions. The findings highlight the need for institutional-level support in addition to capacity building among nurses. [ABSTRACT FROM AUTHOR]

Within the context of services to prevent or treat alcohol-related problems, the terms 'alcohol screening' and 'brief intervention', include all practices used to identify a real or potential alcohol problem, and motivate individuals to take positive action to promote health. Alcohol misuse and dependence affect 8.2 million adults in England, leading to an estimated cost to society of £20bn per annum. Alcohol misuse is now the third leading cause of ill health after tobacco use and high blood pressure. During the past 20 years, randomised controlled trials of brief interventions have been conducted in diverse practice settings. These have included hospital accident and emergency services, medical inpatients units and primary healthcare settings, such as General Practitioner (GP) surgeries. Currently there are no established services or training opportunities in the UK, for community pharmacists to engage in managing alcohol-related problems. It is well known that community pharmacies allow the general public to seek healthcare advice. The potential benefits of preventing alcohol problems through pharmacists' involvement in brief intervention have yet to be measured and further research is required. This paper therefore aims to explore the following questions: • What is the evidence for brief intervention and commutation methodology in public health? • How can community pharmacists be involved in conducting brief alcohol intervention? • What would be a good practice guide for pharmacists to communicate safe drinking advice to harmful and or hazardous drinkers, accessing community pharmacy services? • How could the potential benefits of brief intervention led by community pharmacists be measured? [ABSTRACT FROM AUTHOR]

Background: An estimated 15.1 million adults ages 18 years and older are classified with an alcohol use disorder, which includes 9.8 million men and 5.3 million women. A brief intervention is indicated for those identified to be at risk because of alcohol use. Objective: To determine the feasibility and acceptability of informational videos about alcohol use. Design: This feasibility study provided participants with the opportunity to choose one of two videos, Alcohol and the Brain or Rethinking Drinking. An online survey was administered to all study participants to identify alcohol-related risk, readiness to decrease use, and knowledge pertaining to alcohol use. Results: The two videos provided in this study were feasibly delivered in an on-line format to 129 adults, including 115 males and 5 females identified to be at risk. Knowledge scores increased only slightly. There were mixed results for the readiness scores. Conclusions: Future research should examine the efficacy of these two alcohol brief interventions on alcohol-related outcomes. [ABSTRACT FROM AUTHOR]

Providing antenatal and postnatal support for women who drink alcohol in pregnancy is only possible if those at risk can be identified. However, screening will only be helpful if women feel comfortable with the method used. We conducted a survey of pregnant women and their partners to investigate self-reported beliefs and practice regarding drinking during pregnancy and the acceptability of screening. Pregnant women and their partners attending antenatal clinics in North-East England were asked to complete a short survey regarding their alcohol consumption in pregnancy, their beliefs about safe levels of alcohol in pregnancy and whether they would be happy to have their blood or their baby's meconium analysed for alcohol biomarkers. The data were summarised using descriptive statistics and thematic analysis. A total of 171 pregnant women and 41 partners participated. Of the pregnant women, 153 (89.5%) felt women should abstain from alcohol consumption, although only 70 (40.9%) reported not drinking in pregnancy. Of 96 women who reported drinking in pregnancy and reported when they stopped, all but six (6.3%) stopped drinking when they found out they were pregnant. Of women and partners who recorded an answer, 177 (87.2%) said they would consent to blood biomarker analysis. Confusion over what level of alcohol is safe and using screening as an opportunity for education and support emerged as key themes from free-text responses. Most women viewed screening for alcohol in pregnancy positively, although its acceptability in the small number of women who continue to drink is unclear. [ABSTRACT FROM AUTHOR]

Background: Risky drinking is associated with risky sexual experiences, however the relationship between alcohol and sex is complex. The aim of the study was to assess the feasibility of delivering alcohol screening and brief interventions in genitourinary medicine (GUM) clinics. The objectives were to; understand the levels of alcohol use amongst patients; report on the number of alcohol interventions delivered; and to analyse the relationship between alcohol use with demographic data as well as diagnosed sexually transmitted infections (STIs) to see if there were any associations.Methods: All new patients attending GUM between April 2012 and March 2013 self-completed the Alcohol Use Disorder Identification Test (AUDIT) prior to their clinical consultation. Where appropriate (scoring 8+ on AUDIT) the clinician would deliver up to 2-3 min of alcohol brief intervention. Descriptive statistics, t-tests, ANOVA and logistic regression were carried out as appropriate.Results: AUDIT scores were available for 90% of all new patients (3058/3390) with an average mean score of 7.75. Of those who drank alcohol, 44% were categorised as being AUDIT positive, including 2% who had a score indicative of probable alcohol dependence (20+). 55 % (n = 638) of patients who screened positive on the AUDIT received a brief intervention whilst 24% (n = 674) of drinkers were diagnosed with a STI. Logistic regression modelling revealed that males, younger age groups and those of 'white' ethnicity were more likely to score positive on AUDIT. Patients classified as non-students, living in deprivation quintiles one to four and categorised as probable alcohol dependence on the AUDIT were more likely to be diagnosed with an STI.Conclusion: It is possible to embed alcohol screening into routine practice within sexual health services however further work is required to embed brief interventions particularly amongst increasing risk drinkers. If resources are limited, services may consider more targeted rather than universal alcohol screening to specific population groups. The study was undertaken in one GUM service in the North East of England and therefore findings may not be generalizable. The study did not assess efficacy of alcohol brief intervention in this setting. [ABSTRACT FROM AUTHOR]

• INTRODUCTION This paper provides a comprehensive view of the implementation of alcohol, screening, brief intervention, and referral to treatment (SBIRT) in the primary health care system of the region of Ribeirão Preto, in the State of São Paulo, Brazil, mostly concerning the evaluation of SBIRT training. • METHODS The data were obtained from a community-based study of 776, public primary health care professionals enrolled in an SBIRT training and implementation program in the region of Ribeirão Preto, SP, Brazil from 2003 to 2008. The majority of health professionals who attended the trainings were community health agents (59%) working in the Family Health Program. Physicians, psychologists and nurses also contributed. Data collection was performed using self-report questionnaires, direct interviews, observational, methods and focus groups. • RESULTS There was a statistically significant decrease in health professionals' positive beliefs about alcohol consumption in the post-training period and a significant increase in SBIRT knowledge. Among professional groups, physicians and nurses showed most improvement in their perceived feeling of being "prepared to counsel" patients about risky alcohol use. Qualitative analysis showed an improvement in the level, of awareness of alcohol problems, adoption of a disease model, and an increase in referrals for alcohol treatment. The program was disseminated to a large enough proportion of the health professionals in small, cities to have a significant reach into the general, population of heavy drinkers. • CONCLUSION The training model combined with concurrent supervision and support seem to be effective in the implementation of SBIRT in the routine of health professionals in primary hearth care. This model shows promise as a way to implement alcohol screening and brief intervention as a standard practice in primary health care in large population areas of Brazil. It has been extended to other parts of Brazil and could serve as a model for other Latin-American countries. [ABSTRACT FROM AUTHOR]

Introduction: Heavy episodic ("binge") drinking among women in Scotland is commonplace; prepregnancy drinking is associated with continued antenatal drinking. Evidence for effectiveness of standardized antenatal alcohol assessment is lacking. Alcohol-exposed pregnancies may be missed. We assessed peri-conceptual and mid-pregnancy consumption using a week-long retrospective diary and standard alcohol questionnaires, and evaluated the agreement between these instruments.Material and Methods: Cross-sectional study in two Scottish health board areas involving 510 women attending mid-pregnancy ultrasound scan clinics. Face-to-face administration of alcohol retrospective diary and AUDIT or AUDIT-C assessed weekly and daily alcohol consumption levels and patterns. Depression-Anxiety-Stress Scale (DASS-21) assessed maternal wellbeing. A sub-sample (n = 30) provided hair for alcohol metabolite analysis. Pearson's correlation coefficient investigated associations between questionnaires and alcohol metabolite data.Results: The response rate was 73.8%. The retrospective diary correlated moderately with AUDIT-C and AUDIT but elicited reports of significantly higher peri-conceptual consumption, (median unit consumption on "drinking days" 6.8; range 0.4-63.8). Additional "special occasions" consumption ranged from 1 to 125 units per week. Correlations between DASS-21 and retrospective diary were weak. Biomarker analysis identified three instances of hazardous peri-conceptual drinking.Conclusions: Women reported higher consumption levels when completing the retrospective diary, especially regarding peri-conceptual "binge" drinking. Routine clinical practice methods may not capture potentially harmful or irregular drinking patterns. Given the association between prepregnancy and antenatal drinking, and alcohol's known teratogenic effects, particularly in the first trimester, the retrospective diary may be a useful low-tech tool to gather information on alcohol intake patterns and levels. [ABSTRACT FROM AUTHOR]

Aims To evaluate the association between Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) alcohol screening scores, collected as part of routine clinical care, and three outcomes in the following year (Aim 1), and the association between changes in AUDIT-C risk group at 1-year follow-up and the same outcomes in the subsequent year (Aim 2). Design Cohort study. Setting Twenty-four US Veterans Affairs (VA) healthcare systems (2004-07), before systematic implementation of brief intervention. Participants A total of 486 115 out-patients with AUDIT-Cs documented in their electronic health records (EHRs) on two occasions ≥ 12 months apart ('baseline' and 'follow-up'). Measurements Independent measures were baseline AUDIT-C scores and change in standard AUDIT-C risk groups (no use, low-risk use and mild, moderate, severe misuse) from baseline to follow-up. Outcome measures were (1) high-density lipoprotein cholesterol (HDL), (2) alcohol-related gastrointestinal hospitalizations ('GI hospitalizations') and (3) physical trauma, each in the years after baseline and follow-up. Findings Baseline AUDIT-C scores had a positive association with outcomes in the following year. Across AUDIT-C scores 0-12, mean HDL ranged from 41.4 [95% confidence interval (CI) = 41.3-41.5] to 53.5 (95% CI = 51.4-55.6) mg/l, and probabilities of GI hospitalizations from 0.49% (95% CI = 0.48-0.51%) to 1.8% (95% CI = 1.3-2.3%) and trauma from 3.0% (95% CI = 2.95-3.06%) to 6.0% (95% CI = 5.2-6.8%). At follow-up, patients who increased to moderate or severe alcohol misuse had consistently higher mean HDL and probabilities of subsequent GI hospitalizations or trauma compared with those who did not ( P-values all < 0.05). For example, among those with baseline low-risk use, in those with persistent low-risk use versus severe misuse at follow-up, the probabilities of subsequent trauma were 2.65% (95% CI = 2.54-2.75%) versus 5.15% (95% CI = 3.86-6.45%), respectively. However, for patients who decreased to lower AUDIT-C risk groups at follow-up, findings were inconsistent across outcomes, with only mean HDL decreasing in most groups that decreased use ( P-values all < 0.05). Conclusions When AUDIT-C screening is conducted in clinical settings, baseline AUDIT-C scores and score increases to moderate-severe alcohol misuse at follow-up screening appear to have predictive validity for HDL cholesterol, alcohol-related gastrointestinal hospitalizations and physical trauma. Decreasing AUDIT-C scores collected in clinical settings appear to have predictive validity for only HDL. [ABSTRACT FROM AUTHOR]

Objective: The Alcohol Use Disorders Identification Test (AUDIT) has been developed to screen for hazardous and harmful alcohol consumption. It has been used among a variety of primary care, general population and general hospital populations. However, with the exception of one study undertaken by the author and colleagues, the use of the AUDIT in general hospital psychiatric patients has not been reported. This paper reports on a substudy of this larger study whose aim was to determine the frequency of hazardous alcohol use and dependence among patients admitted to the psychiatric units of general hospitals in Perth, Western Australia, and discusses major reasons for non-AUDIT screening among this group. Method: In a 12-month period 990 patients aged 18–64 years and residing in the Perth metropolitan area were admitted to the psychiatric unit of the two hospitals. Using the AUDIT alcohol use in patients with four major types of psychiatric disorder, namely mood, adjustment, anxiety and psychotic disorders, was assessed. Results: Of the 834 admissions targeted for AUDIT screening 263 were not screened. This non-screening represented 27–42% of patients in each of the major diagnostic categories. There was no significant difference in the proportion of patients screened versus not screened for mood, adjustment or schizophrenia/psychosis. There were however, significantly fewer patients with anxiety disorder screened compared with mood disorder. Those non-screened patients in major psychiatric groups had significantly shorter hospital stays than their diagnostic counterparts who were screened. The major reason for non-screening in all groups was due to patients leaving the psychiatric facility before they could be accessed. This included discharge before screening, transfer to another psychiatric facility and short admission. To a lesser extent cognitive dysfunction accounted for non-screening among major diagnostic groups. Conclusions: Failure to... [ABSTRACT FROM AUTHOR]

Background: Unhealthy alcohol use is a major contributor to the global burden of disease and injury. The US Preventive Services Task Force has recommended alcohol screening and intervention in general medical settings since 2004. Yet less than one in six US adults report health care professionals discussing alcohol with them. Little is known about methods for increasing implementation; different staffing models may be related to implementation effectiveness. This implementation trial compared delivery of alcohol screening, brief intervention and referral to specialty treatment (SBIRT) by physicians versus non-physician providers receiving training, technical assistance, and feedback reports. Methods: The study was a cluster randomized implementation trial (ADVISe [Alcohol Drinking as a Vital Sign]). Within a private, integrated health care system, 54 adult primary care clinics were stratified by medical center and randomly assigned in blocked groups of three to SBIRT by physicians (PCP arm) versus non-physician providers and medical assistants (NPP and MA arm), versus usual care (Control arm). NIH-recommended screening questions were added to the electronic health record (EHR) to facilitate SBIRT. We examined screening and brief intervention and referral rates by arm. We also examined patient-, physician-, and system-level factors affecting screening rates and, among those who screened positive, rates of brief intervention and referral to treatment. Results: Screening rates were highest in the NPP and MA arm (51 %); followed by the PCP arm (9 %) and the Control arm (3.5 %). Screening increased over the 12 months after training in the NPP and MA arm but remained stable in the PCP arm. The PCP arm had higher brief intervention and referral rates (44 %) among patients screening positive than either the NPP and MA arm (3.4 %) or the Control arm (2.7 %). Higher ratio of MAs to physicians was related to higher screening rates in the NPP and MA arm and longer appointment times to screening and intervention rates in the PCP arm. Conclusion: Findings suggest that time frames longer than 12 months may be required for full SBIRT implementation. Screening by MAs with intervention and referral by physicians as needed can be a feasible model for increasing the implementation of this critical and under-utilized preventive health service within currently predominant primary care models. Trial registration: Clinical Trials NCT01135654 [ABSTRACT FROM AUTHOR]

BACKGROUND: Approximately one in six adults in the United States (U.S.) binge drinks. The U.S. Preventive Services Task Force recommends that primary care physicians screen patients for such hazardous alcohol use, and when warranted, deliver a brief intervention. OBJECTIVE: We aimed to determine primary care residents' current practices, perceived barriers and confidence with conducting alcohol screening and brief interventions (SBI). DESIGN: This was a multi-site, cross-sectional survey conducted from March 2010 through December 2012. PARTICIPANTS: We invited all residents in six primary care residency programs (three internal medicine programs and three family medicine programs) to participate. Of 244 residents, 210 completed the survey (response rate 86 %). MAIN MEASURES: Our survey assessed residents' alcohol screening practices (instruments used and frequency of screening), perceived barriers to discussing alcohol, brief intervention content, and self-rated ability to help hazardous drinkers. To determine the quality of brief interventions delivered, we examined how often residents reported including the three key recommended elements of feedback, advice, and goal-setting. KEY RESULTS: Most residents (60 %, 125/208) reported 'usually' or 'always' screening patients for alcohol misuse at the initial clinic visit, but few residents routinely screened patients at subsequent acute-care (17 %, 35/208) or chronic-care visits (33 %, 68/208). Only 19 % (39/210) of residents used screening instruments capable of detecting binge drinking. The most frequently reported barrier to SBI was lack of adequate training (54 %, 108/202), and only 21 % (43/208) of residents felt confident they could help at -risk drinkers. When residents did perform a brief intervention, only 24 % (49/208) 'usually' or 'always' included the three recommended elements. CONCLUSIONS: A minority of residents in this multi-site study appropriately screen or intervene with at-risk alcohol users. To equip residents to effectively address hazardous alcohol use, there is a critical need for educational and clinic interventions to support alcohol-related SBI. [ABSTRACT FROM AUTHOR]

Objective:Alcohol misuse can coexist with and/or contribute to the development of cognitive impairment in the older adult population but continues to be underestimated and undetected in older people. This study aimed to examine the feasibility and acceptability of routine screening for alcohol misuse in a small sample of older people with cognitive impairment receiving services in memory clinics.Methods:This study employed a qualitative and exploratory design, using a convenience sample of individuals attending a memory clinic in England. Ten service users older than 65 with a diagnosis of cognitive impairment (i.e., mild cognitive impairment or dementia) took part in the study. Individuals who met inclusion criteria were invited to take part in an hour-long interview, which included the interviewer administering the alcohol screening tools. Interview transcripts were analyzed using thematic analysis.Results:Participants were able to engage with the screening tools and could, with assistance, complete them in a collaborative and timely manner without distress. All participants reported that these tools were acceptable as part of the clinic assessment. Administering the screening tools was not time-consuming or difficult, making their use feasible within the memory clinic setting. While there were some challenges (e.g., arithmetic, recall, language problems), these challenges could be overcome with the aid of the person administering the screening tool using standardized techniques for assessment administration.Conclusions:Routine screening for alcohol misuse in older people with cognitive impairment receiving services in memory clinics is feasible and acceptable. The process of completing alcohol screening tools with older adults receiving services at memory clinics may increase awareness of the potential impact of alcohol on cognitive functioning and provide practitioners with an opportunity to educate service users about the ways that their drinking is affecting their memory. Several techniques to facilitate completion of screening tools were identified. Future research should evaluate the reliability and validity of alcohol screening tools with older people through corroborating screening results with other assessment methods. [ABSTRACT FROM AUTHOR]

The article talks about alcohol misuse found in dental patients. It states that dental professionals must adopt a preventive approach towards patient's oral care. Topics include impact of alcoholism on oral and general health, guidelines of safe drinking in Great Britain, and medical history of alcoholism.

Background: Drinking motives are thought to be important mediators of the relationship between social anxiety and alcohol use. This project evaluates whether specific drinking motives accurately reflect alcohol dependence. If so, brief questions about drinking motives could serve as valuable alcohol screening tools with socially anxious patients. Methods: This investigation was a secondary analysis of an existing data set of 83 subjects with social anxiety disorder and at-risk alcohol use. The relationship between Drinking Motives Questionnaire (DMQ-R-5) subscales and alcohol dependence was evaluated. Results: Coping-Depression was the only subscale that contributed to the unique prediction of a diagnosis of alcohol dependence. Additionally, two items (i.e. 'to cheer up when you're in a bad mood' and 'to forget painful memories') predicted a diagnosis of alcohol dependence above and beyond their association with each other. Conclusions: Among patients with social anxiety, two specific questions on the DMQ-R-5 could provide a useful screen for health professionals to predict alcohol dependence. It may be fruitful to specifically target the motives of 'to cheer up when you're in a bad mood' and 'to forget painful memories' when providing advice during brief interventions. [ABSTRACT FROM AUTHOR]

Background: Substance use among older adults is an increasing concern, with the prevalence of substance use in older populations expected to double in the next decade. Drug and alcohol use is associated with trauma risk and outcomes, but little is known about the specific risk for older trauma patients. Objectives: To evaluate the association between drug and alcohol use and trauma outcomes among adults aged 55 years and older. Methods: This retrospective observational study included older adults from the Illinois Trauma Registry between 1999 and 2009. Exclusion criteria were age younger than 55 years or absent date of birth, ethanol level, or urine drug screen (UDS). Alcohol intoxication was defined as ethanol level greater than 80 mg/dL. UDS was used to screen cocaine and marijuana use. Analyses, for both the alcohol and the marijuana/cocaine groups, compared outcomes for patients with negative vs. positive screens. Results: 21 320 patients were included in the alcohol analysis and 17 077 in the drug analysis. Compared to non-intoxicated patients, alcohol-intoxicated patients had significantly ( p < 0.001) lower in-hospital mortality, decreased ICU admission, decreased intubation rate, and shorter hospital length of stay. Patients screening positive for cocaine or marijuana had significantly longer lengths of stay with increased ICU admission compared with those who screened negative. Conclusion: Among older trauma patients, this study shows significant associations with multiple trauma outcomes, including one between elevated ethanol concentrations and improved outcomes. Future research into the causes of these findings could inform the care of older trauma patients and aid in prevention of injuries. [ABSTRACT FROM AUTHOR]

Background The AUDIT-C is an extensively validated screen for unhealthy alcohol use (i.e. drinking above recommended limits or alcohol use disorder), which consists of three questions about alcohol consumption. AUDIT-C scores ⩾4 points for men and ⩾3 for women are considered positive screens based on US validation studies that compared the AUDIT-C to "gold standard" measures of unhealthy alcohol use from independent, detailed interviews. However, results of screening-positive or negative based on AUDIT-C scores-can be inconsistent with reported drinking on the AUDIT-C questions. For example, individuals can screen positive based on the AUDIT-C score while reporting drinking below US recommended limits on the same AUDIT-C. Alternatively, they can screen negative based on the AUDIT-C score while reporting drinking above US recommended limits. Such inconsistencies could complicate interpretation of screening results, but it is unclear how often they occur in practice. Methods This study used AUDIT-C data from respondents who reported past-year drinking on one of two national US surveys: a general population survey (N = 26,610) and a Veterans Health Administration (VA) outpatient survey (N = 467,416). Gender-stratified analyses estimated the prevalence of AUDIT-C screen results-positive or negative screens based on the AUDIT-C score-that were inconsistent with reported drinking (above or below US recommended limits) on the same AUDIT-C. Results Among men who reported drinking, 13.8% and 21.1% of US general population and VA samples, respectively, had screening results based on AUDIT-C scores (positive or negative) that were inconsistent with reported drinking on the AUDIT-C questions (above or below US recommended limits). Among women who reported drinking, 18.3% and 20.7% of US general population and VA samples, respectively, had screening results that were inconsistent with reported drinking. Limitations This study did not include an independent interview gold standard for unhealthy alcohol use and therefore cannot address how often observed inconsistencies represent false positive or negative screens. Conclusions Up to 21% of people who drink alcohol had alcohol screening results based on the AUDIT-C score that were inconsistent with reported drinking on the same AUDIT-C. This needs to be addressed when training clinicians to use the AUDIT-C. [ABSTRACT FROM AUTHOR]

Background: The AUDIT-C is an extensively validated screen for unhealthy alcohol use (i.e. drinking above recommended limits or alcohol use disorder), which consists of three questions about alcohol consumption. AUDIT-C scores ⩾4 points for men and ⩾3 for women are considered positive screens based on US validation studies that compared the AUDIT-C to "gold standard" measures of unhealthy alcohol use from independent, detailed interviews. However, results of screening—positive or negative based on AUDIT-C scores—can be inconsistent with reported drinking on the AUDIT-C questions. For example, individuals can screen positive based on the AUDIT-C score while reporting drinking below US recommended limits on the same AUDIT-C. Alternatively, they can screen negative based on the AUDIT-C score while reporting drinking above US recommended limits. Such inconsistencies could complicate interpretation of screening results, but it is unclear how often they occur in practice. Methods: This study used AUDIT-C data from respondents who reported past-year drinking on one of two national US surveys: a general population survey (N = 26,610) and a Veterans Health Administration (VA) outpatient survey (N = 467,416). Gender-stratified analyses estimated the prevalence of AUDIT-C screen results—positive or negative screens based on the AUDIT-C score—that were inconsistent with reported drinking (above or below US recommended limits) on the same AUDIT-C. Results: Among men who reported drinking, 13.8% and 21.1% of US general population and VA samples, respectively, had screening results based on AUDIT-C scores (positive or negative) that were inconsistent with reported drinking on the AUDIT-C questions (above or below US recommended limits). Among women who reported drinking, 18.3% and 20.7% of US general population and VA samples, respectively, had screening results that were inconsistent with reported drinking. Limitations: This study did not include an independent interview gold standard for unhealthy alcohol use and therefore cannot address how often observed inconsistencies represent false positive or negative screens. Conclusions: Up to 21% of people who drink alcohol had alcohol screening results based on the AUDIT-C score that were inconsistent with reported drinking on the same AUDIT-C. This needs to be addressed when training clinicians to use the AUDIT-C. [ABSTRACT FROM AUTHOR]

In 2010/2011, there were over 21 million attendances at English Emergency Departments (EDs), of which 35% are estimated to be alcohol-related. Screening in EDs could have considerable impact in identifying alcohol use disorders and directing people to appropriate interventions. We aimed to describe the screening and profile of risky single occasion drinkers (RSOD) in Nottingham University Hospitals (NUH) NHS Trust ED. Routine admissions data and alcohol screening responses for each patient aged 18 years and over were accessed from the ED information system (EDIS) for a period of 12 months. Of the 99,728 presentations at ED, 55,564 (55.72%) were screened and, of these, 8131 (16.81%) screened positive for RSOD. Compared with those who screened negative, they were 2.63 times more likely to present with injuries. However, the majority ( N = 5389, 66.28%) said their current presentation was not related to alcohol consumption. Of those who screened RSOD positive only 1.75% accepted a referral for advice; the majority (85.29%) accepted an information leaflet. Improvements to the screening process are suggested, including potentially targeting screening, using an assessment that may in itself have an impact on drinking outcomes, and improving the relevance of leaflets and brief interventions to specific subgroups of patients. [ABSTRACT FROM AUTHOR]

This study provides preliminary evidence of the effectiveness of the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) and ASSIST-linked brief intervention in a college mental health clinic. Data are from a single group, pre-post evaluation study (2006–2009) at a university counseling center. Students deemed to be at risk for substance use problems were offered the ASSIST and the ASSIST-linked brief intervention. Staff therapists administered the ASSIST and intervention as part of routine care; 453 students (ages 18–24) participated in the evaluation and completed baseline and six-month follow-up interviews. Changes in alcohol and marijuana use were examined by McNemar's test of proportions and by paired t-tests for means. Slight reductions in the rates and number of days (in the prior 30 days) of binge drinking and marijuana use were found. Routine screening and brief intervention procedures in a mental health setting may reduce problematic substance use among college students. [ABSTRACT FROM PUBLISHER]

Background: Alcohol consumption is a risk factor for traumatic injury, but it is unknown whether responses to alcohol screening questionnaires administered routinely in primary care are associated with subsequent hospitalization for traumatic injury. Objective: We evaluated the association between alcohol screening scores and the risk for subsequent hospitalizations for trauma among Veterans Affairs (VA) general medicine patients. Method: This study included VA outpatients ( n == 32,623) at seven sites who returned mailed surveys (1997-1999). Alcohol Use Disorders Identification Test Consumption (AUDIT-C) scores grouped patients into six drinking categories representing nondrinkers, screen-negative drinkers, and drinkers who screened positive for mild, moderate, severe, and very severe alcohol misuse (scores 0, 1-3, 4-5, 6-7, 8-9, 10-12, respectively). VA administrative and Medicare data identified primary discharge diagnoses for trauma. Cox proportional hazard models were used to estimate the risk of trauma-related hospitalization for each drinking group adjusted for demographics, smoking, and comorbidity. Results: Compared with screen-negative drinkers, patients with severe and very severe alcohol misuse (AUDIT-C 8-9 and ≥10) were at significantly increased risk for trauma-related hospitalization over the follow-up period (adjusted hazard ratios AUDIT-C: 8-9 2.06, 95%% confidence interval (CI) 1.31- 3.24 and AUDIT-C≥10 2.13, 95%% CI 1.32-3.42). Conclusions: Patients with severe and very severe alcohol misuse had a twofold increased risk of hospital admission for trauma compared to drinkers without alcohol misuse. Scientific Significance: Alcohol screening scores could be used to provide feedback to patients regarding risk of trauma-related hospitalization. Findings could be used by providers during brief alcohol-related interventions with patients with alcohol misuse. [ABSTRACT FROM AUTHOR]

Background: Alcohol screening questionnaires have typically been validated when self- or researcher-administered. Little is known about the performance of alcohol screening questionnaires administered in clinical settings.Objective: The purpose of this study was to compare the results of alcohol screening conducted as part of routine outpatient clinical care in the Veterans Affairs (VA) Health Care System to the results on the same alcohol screening questionnaire completed on a mailed survey within 90 days and identify factors associated with discordant screening results.Design: Cross sectional.Participants: A national sample of 6,861 VA outpatients (fiscal years 2007-2008) who completed the AUDIT-C alcohol screening questionnaire on mailed surveys (survey screen) within 90 days of having clinical AUDIT-C screening documented in their medical records (clinical screen).Main Measures: Alcohol screening results were considered discordant if patients screened positive (AUDIT-C ≥ 5) on either the clinical or survey screen but not both. Multivariable logistic regression was used to estimate the prevalence of discordance in different patient subgroups based on demographic and clinical characteristics, VA network and temporal factors (e.g. the order of screens).Key Results: Whereas 11.1% (95% CI 10.4-11.9%) of patients screened positive for unhealthy alcohol use on the survey screen, 5.7% (5.1- 6.2%) screened positive on the clinical screen. Of 765 patients who screened positive on the survey screen, 61.2% (57.7-64.6%) had discordant results on the clinical screen, contrasted with 1.5% (1.2-1.8%) of 6096 patients who screened negative on the survey screen. In multivariable analyses, discordance was significantly increased among Black patients compared with White, and among patients who had a positive survey AUDIT-C screen or who received care at 4 of 21 VA networks.Conclusion: Use of a validated alcohol screening questionnaire does not-by itself-ensure the quality of alcohol screening. This study suggests that the quality of clinical alcohol screening should be monitored, even when well-validated screening questionnaires are used. [ABSTRACT FROM AUTHOR]

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Although there have been efforts to advance evidenced-based practices into community-based organizations the limited successes of dissemination and poor implementation of efficacious treatments within these organizations are beginning to be documented. This article builds on the knowledge gained from organizational research and those internal structures (e.g., culture and climate), which possibly impede or enhance evidenced-based practice implementation within community-based organizations. While there are many evidenced-based practices available to human services organizations, there seems to be a gap between research and the implementation of these clinical practices. Recommendations are provided to better enable community-based organizations to integrate evidenced-based practice into its existing service structures. [ABSTRACT FROM AUTHOR]

Meta-analytic methods provide a framework around which an inquiry into MAST and SMAST score reliability was completed. Of the 470 measurement opportunities observed between 1971 and 2005, 62 (13.2%) were coupled with accurate reliability information. Weighted reliability estimates centered on .80 suggesting that the MAST and SMAST generally produce scores of similar and adequate reliability for most research purposes. However, the variability of internal consistency estimates shows that at times these tools will not produce reliable scores, particularly among female and nonclinical respondents. Multiple regression equations provide practical guidelines to improve reliability estimates for the future use of these instruments. [ABSTRACT FROM AUTHOR]

Background: Alcohol misuse is a common cause of liver disease, upper gastrointestinal (GI) bleeding, and pancreatitis, but it is not known whether alcohol screening questionnaires can identify patients at increased risk for hospitalizations due to these conditions. Objective: To evaluate the association of alcohol screening scores with the risk of subsequent hospitalization for alcohol-related GI conditions. Design: Retrospective cohort study. Participants: Male general medicine outpatients from 7 Veterans Affairs (VA) medical centers who returned mailed questionnaires. Measurements: The CAGE questionnaire (0–4 points) and the Alcohol Use Disorders Identification Test-Consumption questions (AUDIT-C; 0–12 points) were included on mailed surveys. The main outcome, “GI hospitalization,” was a primary VA or Medicare discharge diagnosis indicating liver disease, upper GI bleeding, or pancreatitis. Results: Among 31,311 patients followed, a median of 3.75 years, patients with CAGE scores ≥2 points or AUDIT-C scores ≥6 points were at a significantly increased risk for GI hospitalizations. Adjusted hazard ratios (HRadj) ranged from 1.6 (95% CI 1.2–2.0) for CAGE score 2, to 1.7 (1.4–2.2) for CAGE 4, and from 1.4 (1.01–2.0) for AUDIT-C scores from 6 to 7, to 2.7 (1.9–3.8) for AUDIT-C scores from 10 to 12. Secondary analyses demonstrated that the association was the strongest among patients less than 50 years of age who reported drinking in the past year. Conclusions: Brief alcohol screening questionnaires predict subsequent hospitalizations for alcohol-related GI conditions. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate whether providing physicians and older patients with personalized reports of drinking risks and benefits and patient education reduces alcohol-related risks and problems. Design: Prospective comparison study. Setting: Community primary care. Participants: Twenty-three physicians and 665 patients aged 65 and older. Intervention: Combined report, in which six physicians and 212 patients received reports of patients' drinking classifications and patients also received education; patient report, in which 245 patients received reports and education, but their five physicians did not receive reports; and usual care. Measurements: Assessments at baseline and 12 months later to determine patients' nonhazardous (no known risks), hazardous (risks for problems), or harmful (presence of problems) classifications using the Computerized Alcohol-Related Problems Survey (CARPS). The CARPS contains a scanned screening measure and scoring algorithms and automatically produces patient and physician reports and patient education. Results: At baseline, 21% were harmful drinkers, and 26% were hazardous drinkers. The patient report and combined report interventions were each associated with greater odds of lower-risk drinking at follow-up than usual care (odds ratio=1.59 and 1.23, respectively, P<.05 for each). The patient report intervention significantly reduced harmful drinking at follow-up from an expected 21% in usual care to 16% and increased nonhazardous drinking from 52% expected in usual care to 58%. Patients in the combined report intervention experienced a significantly greater average decrease in quantity and frequency. Conclusion: Older primary care patients can effectively reduce their alcohol consumption and other drinking risks when given personalized information about their drinking and health. [ABSTRACT FROM AUTHOR]

Alcohol Drinking Patterns and Health Care Utilization in a Managed Care Organization Gary A. Zarkin, Jeremy W. Bray, Thomas F. Babor, and John C. Higgins-Biddle Objective. To estimate the relationship between current drinking patterns and health care utilization over the previous two years in a managed care organization (MCO) among individuals who were screened for their alcohol use. Study Design. Three primary care clinics at a large western MCO administered a short health and lifestyle questionnaire to all adult patients on their first visit to the clinic from March 1998 through December 1998. Patients who exceeded the National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines for moderate drinking were given a more comprehensive alcohol screening using a modified version of the Alcohol Use Disorders Identification Test (AUDIT). Health care encounter data for two years preceding the screening visit were linked to the remaining individuals who responded to one or both instruments. Using both quantity­frequency and AUDIT- based drinking pattern variables, we estimated negative binomial models of the relationship between drinking patterns and days of health care use, controlling for demographic characteristics and other variables. Principal Findings. For both the quantity­frequency and AUDIT-based drinking pattern variables, current alcohol useisgenerally associatedwithless healthcare utilization relative to abstainers. This relationship holds even for heavier drinkers, although the differences are not always statistically significant. With some exceptions, the overall trend is that more extensive drinking patterns are associated with lower health care use. Conclusions. Basedonoursample,wefindlittleevidencethatalcoholuseisassociated with increased health care utilization. On the contrary, we find that alcohol use is generally associated with decreased health care utilization regardless of drinking pattern. Key Words. Alcohol, health care utilization, alcohol screening Alcoholism and alcohol abuse impose significant costs on society. One consequence that has received much attention is the possibility that alcohol abuse leads to increased health care utilization. Although the alcohol treatment cost offset literature (e.g., Holder and Blose 1991, 1992; Holder and Cunningham 1992; Holder, Lennox, and Blose 1992) has demonstrated that untreated alcoholics have greater health care utilization than nonalco- holics, it does not shed light on the relationship between the level and intensity of alcohol use (as opposed to abuse or dependence) and health care utilization. 553 Because the number of alcohol users is much greater than the number of dependent or abusive drinkers,1 understanding the relationship between alcohol use patterns and health care utilization is important to policymakers. Once this relationship is understood, policymakers need to understand the underlying reasons for the relationship and whether a screening intervention is warranted to detect and change these patterns. Our article contributes to the first part of this research by examining the relationship between alcohol drinking patterns and health care utilization. Several recent studies have examined the relationship between alcohol consumption and health care utilization. In general, the results appear counterintuitive in light of the cost offset literature. For example, Armstrong, Midanik, and Klatsky (1998) found in a survey of health maintenance organization (HMO) users that the heaviest drinkers (as measured by weekly consumption), after adjusting for age and race, had fewer hospital days, fewer hospitalizations, and fewer outpatient visits than abstainers. Rice et al. (2000) examined the relationship between health care use (outpatient visits and odds of hospital use) and alcohol use collected from a member survey at an HMO. Results indicate that current drinkers had lower rates of health care utilization than nondrinkers and that nondrinkers with a drinking history had substantially greater utilization than nondrinkers without a history. Polen et al. (2001) examined the relationship between alcohol consumption (based on a user survey at an HMO) and health care utilization (health care costs, outpatient visits, inpatient days, and emergency room visits). Several patterns of alcohol consumption were created from the AUDIT, including drinks per month. No strong, consistent relationship was found between the multiple drinking patterns and health care utilization cost and use. However, they found that nondrinkers had greater health care costs and utilization than drinkers. Cryer et al. (1999) examined the relationship between alcohol consumption and acute and preventive health care use for a random sample of adults in South East England. They found that although heavy drinkers used more acute care, they also used less preventative care. Interestingly, they This study was funded by a contract to RTI from the University of Connecticut Health Center as part of the Cutting Back s research study funded by the Robert Wood Johnson Foundation. Additional funding was provided by NIAAA (R01­AA 12788). Address correspondence to Gary A. Zarkin, Ph.D., RTI International, 3040 Cornwallis Rd., P.O. Box 12194, Research Triangle Park, NC 27709. Jeremy W. Bray, Ph.D., is also with RTI International. Thomas F. Babor, Ph.D., and John C. Higgins-Biddle, Ph.D., are with the University of Connecticut. 554 HSR: Health Services Research 39:3 (June 2004) found that abstainers were also overusers of acute care but underusers of preventative services. These findings of a negative relationship between alcohol use and health care utilization (with the exception of Cryer et al. 1999) are consistent with the possibility that moderate alcohol consumption may provide beneficial health effects, which in turn may lead to lower health care utilization. Numerous studies have found that moderate alcohol use is associated with reduced risk of coronary heart disease and with reduced overall mortality within certain populations (Doll 1998; Chick 1998; Klatsky 1999; Ashley et al. 1994). Indeed, Doll (1998) concluded that alcohol consumption in the range of one to four drinks per day is associated with reductions in the risk of premature death. Unfortunately, much of the previous literature on alcohol use and health care utilization has focused on measures of weekly or monthly alcohol consumption, and so we cannot determine if the beneficial health effect of regular, moderate drinking explains the results of this literature (an exception is Rice et al. 2000, which used drinks per day). Nor has previous health services research taken into account the quantity­frequency pattern of drinking as we do here. There is evidence, for example, that frequent binge drinking----which is a typical pattern in Russia, Poland, and the Baltic states----is associated with increased mortality and morbidity (Chenet et al. 1998). Further complicating the putative association between drinkers and abstainers is the issue that abstainers include never drinkers and former drinkers, and these two groups are very different. For example, Fillmore et al. (1998) found that former drinkers are more likely to have health risk factors such as cigarette smoking, depression, and obesity. Polen et al. (2001) found that former drinkers have higher health care costs than never drinkers and light drinkers. This study expands the previous literature on the relationship between alcohol use and health care utilization in an MCO by examining two different drinking pattern measures: quantity-frequency and alcohol problem severity measures. In addition, we have included covariates for two important health behaviors----smoking and exercising. Controls for exercise have not been available in the previous literature. We have also included more traditional demographic factors, such as age and gender. DATA AND METHODS Data Data for this analysis were collected as part of Cutting Back s , a six-year, five- site national research project evaluating the application of alcohol screening Drinking Patterns and Health Care Utilization 555 [ABSTRACT FROM AUTHOR]

The CAGE is a commonly used alcohol screening instrument. Although considerable work has been done on the validity of CAGE scores, relatively little information is available on their reliability. Reliability induction and generalization studies were performed for the CAGE. Of the 259 studies available for analysis, only 19(7.3%) contained reliability information for the sample scores. Thirteen (5.0%) and 227 (87.6%) articles made what are designated as reliability induction by report and reliability induction by omission. The median internal consistency reliability across 22 samples was .74, with a range of .52 to .90. Sample age was the only identified sample characteristic that demonstrated a statistically significant relationship with CAGE score reliability. [ABSTRACT FROM AUTHOR]

Alcohol use disorders are primarily characterized by excessive consumption of alcohol and the behavioral, cognitive, and psychosocial problems associated with problem drinking. Although social workers are routinely involved in the treatment of people with problems related to alcohol, there is limited literature in professional social work concerning practical assessment instruments that social workers may use to guide effective practice. This article reviews a number of empirically supported instruments for the diagnosis and assessment of alcohol dependence and abuse in social work practice settings. [ABSTRACT FROM AUTHOR]

Background: Efficient, inexpensive screening for early stage alcohol problems is important in health care settings. The Alcohol Use Disorders Identification Test (AUDIT) has been studied extensively to establish its value in this regard. Methods: A literature search that used EtOH as a database was conducted to identify studies published on the AUDIT through September 2001. Keywords used for the search were 'Alcohol Use Disorders Identification Test' and 'AUDIT.' All studies reporting psychometric properties of the measure were reviewed with particular attention being given to the period 1996 and later. A small number of additional references were located by noting their citation in other studies reviewed. Results: Although more research is needed on non-English versions to establish their psychometric properties, at least in its English edition, the AUDIT demonstrates sensitivities and specificities comparable, and typically superior, to those of other self-report screening measures. Test-retest reliability and internal consistency are also quite favorable. For males, the AUDIT-C, a shortened version of the AUDIT, appears approximately equal in validity to the full scale. Conclusions: Recent research continues to support use of the AUDIT as a means of screening for alcohol use disorders in health care settings in the United States. [ABSTRACT FROM AUTHOR]

Background: Alcohol guidelines enable individuals to make informed choices about drinking and assist healthcare practitioners to identify and treat at-risk drinkers. The UK Low Risk Drinking Guidelines were revised in 2016 and the weekly guideline for men was reduced from 21 to 14 units per week. This study sought to retrospectively establish 1) the number of additional at-risk male drinkers in England, 2) which demographic characteristics were associated with being an at-risk drinker under the previous versus new guidelines.Methods: Average weekly alcohol consumption for men aged 16+ from the cross-sectional nationally representative Health Survey for England were used to 1) calculate annual population prevalence estimates for newly defined at-risk (> 14 to ≤21 units/week) male drinkers from 2011 to 2015 (N = 3487-3790), and 2) conduct logistic regression analyses for at-risk vs low risk male drinkers under the previous (> 21 vs ≤21 units/week) and new (> 14 vs ≤14 units/week) guidelines to assess characteristics associated with being at-risk drinkers under each guideline using 2015 data (N = 2982).Results: Population prevalence estimates of newly defined at-risk drinkers ranged from 10.2% (2014 = 2,182,401 men)-11.2% (2011 = 2,322,896 men). Under the new guidelines, men aged 55-74 (OR = 1.63,95% CI = 1.25-2.12); men in managerial/professional occupations (OR = 1.64,95% CI = 1.34-2.00); current smokers (OR = 2.26,95% CI = 1.73-2.94), ex-regular smokers (OR = 2.01,95% CI = 1.63-2.47) and ex-occasional smokers (OR = 1.85,95% CI = 1.25-2.74); men from the North East (OR = 2.08,95% CI = 1.38-3.13) and North West (OR = 1.91,95% CI = 1.41-2.60) of England all had greater odds, and non-white men had reduced odds (OR = 0.53,95% CI = 0.34-0.80) of being at-risk drinkers, as they had under the previous guidelines. Under the new guidelines only: a higher percentage of at-risk drinkers aged 16-34 (32% vs 19%) attenuated the odds of men aged 35-54 being at-risk (OR = 1.18,95% CI = 0.92-1.51); a higher percentage of married at-risk drinkers (37% vs 24%) attenuated the odds of single men being at-risk (OR = 1.28,95% CI = 0.99-1.67); men from the West Midlands (OR = 1.68,95% CI = 1.17-2.42) and London (OR = 1.53,95% CI = 1.03-2.28) had greater odds of being at-risk drinkers.Conclusions: The change to the Low Risk Drinking Guidelines would have resulted in more than 2 million additional male at-risk drinkers in England. Most groups with greater odds of being at-risk drinkers under the new guidelines were those already known to be drinking the most, strengthening the case for targeted screening and education. Additionally, under the new guidelines, a marked proportion of 16-35 year olds and married men were at-risk and men in the West Midlands and London had greater odds of being at-risk drinkers. These groups may benefit from specific education around the new Low Risk Drinking Guidelines. [ABSTRACT FROM AUTHOR]

Background: Foetal alcohol spectrum disorders (FASDs) are one of the most common preventable forms of developmental disability and congenital abnormalities globally, particularly in countries where alcohol is considered socially acceptable. Screening for alcohol use early in pregnancy can facilitate the detection of alcohol-exposed pregnancies and identify women who require further assessment. However, only a small percentage of children with FASD are identified in the United Kingdom. This may be partly attributed to a lack of awareness of the condition by National Health Service (NHS) health professionals. Methods: We developed an online survey to determine health care professionals' (midwives, health visitors, obstetricians, paediatricians, and general practitioners) perceived knowledge, attitudes, and clinical practices relating to alcohol in pregnancy and FASD. Results: There were a total of 250 responses to the surveys (78 midwives, 60 health visitors, 55 obstetricians, 31 paediatricians, and 26 general practitioners). About 58.1% of paediatricians had diagnosed a patient with foetal alcohol syndrome (FAS) or FASD and 36.7% worried about stigmatisation with diagnosis. Paediatricians reported the highest levels of FASD training (54.8%), with much lower levels in midwives (21.3%). This was reflected in perceived knowledge levels; overall, only 19.8% of respondents knew the estimated UK prevalence of FASD for example. Conclusions: We identified a need for training in alcohol screening in pregnancy and FASD to improve awareness and recognition by UK professionals. This could improve patient care from the antenatal period and throughout childhood. [ABSTRACT FROM AUTHOR]

Background: Foetal alcohol spectrum disorders (FASDs) are one of the most common preventable forms of developmental disability and congenital abnormalities globally, particularly in countries where alcohol is considered socially acceptable. Screening for alcohol use early in pregnancy can facilitate the detection of alcohol-exposed pregnancies and identify women who require further assessment. However, only a small percentage of children with FASD are identified in the United Kingdom. This may be partly attributed to a lack of awareness of the condition by National Health Service (NHS) health professionals. Methods: We developed an online survey to determine health care professionals' (midwives, health visitors, obstetricians, paediatricians, and general practitioners) perceived knowledge, attitudes, and clinical practices relating to alcohol in pregnancy and FASD. Results: There were a total of 250 responses to the surveys (78 midwives, 60 health visitors, 55 obstetricians, 31 paediatricians, and 26 general practitioners). About 58.1% of paediatricians had diagnosed a patient with foetal alcohol syndrome (FAS) or FASD and 36.7% worried about stigmatisation with diagnosis. Paediatricians reported the highest levels of FASD training (54.8%), with much lower levels in midwives (21.3%). This was reflected in perceived knowledge levels; overall, only 19.8% of respondents knew the estimated UK prevalence of FASD for example. Conclusions: We identified a need for training in alcohol screening in pregnancy and FASD to improve awareness and recognition by UK professionals. This could improve patient care from the antenatal period and throughout childhood. [ABSTRACT FROM AUTHOR]

Background: Alcohol and drug use are leading causes of morbidity and mortality that frequently go unidentified in medical settings. As part of a multi-phase study to implement electronic health record-integrated substance use screening in primary care clinics, we interviewed key clinical stakeholders to identify current substance use screening practices, barriers to screening, and recommendations for its implementation. Methods: Focus groups and individual interviews were conducted with 67 stakeholders, including patients, primary care providers (faculty and resident physicians), nurses, and medical assistants, in two urban academic health systems. Themes were identified using an inductive approach, revised through an iterative process, and mapped to the Knowledge to Action (KTA) framework, which guides the implementation of new clinical practices (Graham et al. in J Contin Educ Health Prof 26(1):13–24, 2006 ). Results: Factors affecting implementation based on KTA elements were identified from participant narratives. Identifying the problem: Participants consistently agreed that having knowledge of a patient’s substance use is important because of its impacts on health and medical care, that substance use is not properly identified in medical settings currently, and that universal screening is the best approach. Assessing barriers: Patients expressed concerns about consequences of disclosing substance use, confidentiality, and the individual’s own reluctance to acknowledge a substance use problem. Barriers identified by providers included individual-level factors such as lack of clinical knowledge and training, as well as systems-level factors including time pressure, resources, lack of space, and difficulty accessing addiction treatment. Adapting to the local context: Most patients and providers stated that the primary care provider should play a key role in substance use screening and interventions. Opinions diverged regarding the optimal approach to delivering screening, although most preferred a patient self-administered approach. Many providers reported that taking effective action once unhealthy substance use is identified is crucial. Conclusions: Participants expressed support for substance use screening as a valuable part of medical care, and identified individual-level as well as systems-level barriers to its implementation. These findings suggest that screening programs should clearly communicate the goals of screening to patients and proactively counteract stigma, address staff concerns regarding time and workflow, and provide education as well as treatment resources to primary care providers. [ABSTRACT FROM AUTHOR]

Introduction and aims: Aboriginal and Torres Strait Islander Community Controlled Health Services (ACCHSs) around Australia have been asked to standardise screening for unhealthy drinking. Accordingly, screening with the 3-item AUDIT-C (Alcohol Use Disorders Identification Test—Consumption) tool has become a national key performance indicator. Here we provide an overview of suitability of AUDIT-C and other brief alcohol screening tools for use in ACCHSs. Methods: All peer-reviewed literature providing original data on validity, acceptability or feasibility of alcohol screening tools among Indigenous Australians was reviewed. Narrative synthesis was used to identify themes and integrate results. Results: Three screening tools—full AUDIT, AUDIT-3 (third question of AUDIT) and CAGE (Cut-down, Annoyed, Guilty and Eye-opener) have been validated against other consumption measures, and found to correspond well. Short forms of AUDIT have also been found to compare well with full AUDIT, and were preferred by primary care staff. Help was often required with converting consumption into standard drinks. Researchers commented that AUDIT and its short forms prompted reflection on drinking. Another tool, the Indigenous Risk Impact Screen (IRIS), jointly screens for alcohol, drug and mental health risk, but is relatively long (13 items). IRIS has been validated against dependence scales. AUDIT, IRIS and CAGE have a greater focus on dependence than on hazardous or harmful consumption. Discussion and conclusions: Detection of unhealthy drinking before harms occur is a goal of screening, so AUDIT-C offers advantages over tools like IRIS or CAGE which focus on dependence. AUDIT-C’s brevity suits integration with general health screening. Further research is needed on facilitating implementation of systematic alcohol screening into Indigenous primary healthcare. [ABSTRACT FROM AUTHOR]